Carers Resilience Enablement Grant Application Form

About this grant

In order for us to accept your application, you need to have a reference from a support worker from one of the following organisations:
Kernow Carers Service
Age UK
Disability Cornwall
Action for Children (for carers over 18)
Inclusion Matters
Winter Wellbeing

Your support worker will need to complete the reference found on the grant's home page or contact us for a copy. We cannot accept any application without the endorsement of a support worker.

If you do not currently have a support worker, you can call the Family Information Service on 0800 587 8191 and ask to be referred to Kernow Carers Service for help with this grant.
About this form

Please note, this application form can be saved partway through. Please click the Save and Continue Later link at the bottom of any page. You will be asked to supply your email address and you will be emailed a link to your application form so that you can continue to complete it at a later date.

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Please do not give any specific medical information in this form, e.g. a health diagnosis as, under EU General Data Protection Regulations (2018) we are not permitted to hold this information.

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Have you read and understood the Terms and Conditions that accompany this application form?*
- Yes
- No - please get in touch with us with any queries before continuing
Name of carer*
Contact address and postcode*
Daytime telephone number*
Email*

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About your caring role
How many people do you care for?*
No of adults No of children under 18
Can you tell us about the impact of your caring role on your daily life and on your health and wellbeing?*
Please do not give any specific medical information, e.g. a health diagnosis as, under EU General Data Protection Regulations (2018) we are not permitted to hold this information.
Please tick to confirm all carers benefiting from this grant are aged 18 or over*
- Yes carers are over 18
Please tick if you would like us to send you information on either of these services
Kernow Carers Service can provide carers with advice and guidance, advocacy, the opportunity to meet with a Carer Support Co-ordinator and information about benefits

Inclusion Matters can provide information and advice to increase well-being and connection to your community.
- Kernow Carers Service
- Inclusion Matters

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About your funding request
Please note the maximum funding request permitted per category
- Repair or replacement of essential domestic equipment; funding for private care equipment: other urgent domestic need No limit but only reasonable costs permitted
- Emergency local break for carer and supported person: Max £100 per person
What are you requesting funding for?*
- Repair or replacement of essential domestic equipment; funding for private care equipment; other urgent domestic need
- Urgent break
Funding request for repair or replacement of essential domestic equipment; funding for private care equipment
What do you need?*
- Repair of essential domestic equipment
- Replacement of essential domestic equipment
- Funding for private care equipment
- Other urgent domestic need
Please explain how you are prevented from adequately fulfilling your caring role as a result of not having this item?*
Please explain why other funding options are unavailable or not applicable*
Funding request for an urgent break for a carer and supported person in Cornwall
Your funding request*
What is the activity? Where will this take place? When?
Who else, apart from you, will be taking part?*
Please tick all that apply
- Adult you care for
- Child under 18 you care for
Please explain how this activity will improve your quality of life*
Please explain why other funding options are unavailable or not applicable*

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Costings
Please provide below a detailed list of costs that you would like the grant to fund. We need to know ‘what’, ‘how many’, ‘how much’, etc.
If you have it, please submit evidence of these costs with your application. We need to know how you worked out your costs so please send us quotes, website addresses, etc. You can either upload documents below or email them separately to grants@cornwallrcc.org.uk
If you cannot supply evidence you need to tell us why.
Breakdown of costs*
Please list each item or activity on separate rows. To add extra rows, click on the + symbol at the end of the row you've just completed.
Name of item Name, address & website of repairer/ supplier, if known Total cost
Breakdown of costs*
Please list each item or activity on separate rows. To add extra rows, click on the + symbol at the end of the row you've just completed.
Name of activity How many? E.g. 2 people Cost per person/ session Total cost
Please use this box to detail any website addresses that evidence where you got your costings from, if applicable.
Please note, we cannot accept Facebook pages as evidence of costs.
Your webpage link must take us directly to one/some of the costs you are listing above
If you wish to upload evidence of costs please do so here.
You can upload multiple documents if you need to
Drop files here or

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Your bank details
If your application is successful, payment will be made directly into your bank account.
Bank or building society*
Account name*
Account number*
Sort code*

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Carers applying to this grant must be referred by a recognised service that supports carers. All applications must have the endorsement of one of these services.
Please ask your referee to complete the reference request found on the Carers Resilience Enablement Grant homepage . Unfortunately, we are unable to accept applications without this endorsement. Please either ask your support worker to complete the reference online (please see this grant's homepage} or they can download a reference form from the homepage and then send it to us by email to grants@cornwallrcc.org.uk It is your responsibility to ensure we receive your reference before the application deadline.
Name of your referee/ support worker*
Please tick which organisation they work for*
Must be someone from one of the organisations below
- Kernow Carers Service
- Inclusion Matters
- Winter Wellbeing
- Age UK
- Disability Cornwall
- Action for Children

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Would you like to join our mailing list?*
We occasionally send out emails to advise people of events and services that may be of interest to them, including updates on grant programmes. You can choose from the list below which type of emails you would be interested in receiving.
You can unsubscribe at any time using the link at the bottom of each email.
We will not share your name and email address with any other party.
Click here to read our Privacy Statement
- Yes please
- No thank you
Please select your mailing list preferences*
Please tick ALL that apply
- Grants - we will only contact you with information about our grant programmes
- Other CRCC info - receive occasional emails about other services we offer
- About other approved services and organisations

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Important reminder
Please note all activities must take place before 30 June 2021.
All grant monies must be spent by 30 June 2021.
Feedback reports must be sent back within 4 weeks of the final activity using the template provided.
Next steps
Please save a copy of this completed form for your own records. You may need to refer to your application form if we have any queries and you will need to refer to it when completing a feedback report. A copy will be emailed to you after you click SUBMIT

Additional information
Our address is: Grants, CRCC, 2 Princes Street, Truro TR1 2ES
If you need to call us, our number is: 01872 243535
Our email address is: grants@cornwallrcc.org.uk
Data Protection
CRCC complies with the EU General Data Protection Regulations and the Data Protection Act 2018. By sending this form to us, you agree that we can securely store your personal information on our database or in the form of paper records, and that we can use your information in order to provide a service to you as part of the Wellbeing Community Grants Programme.

We will only collect and process information in accordance with the legal basis for the service you are receiving. We will not sell your information or share it with any other organisations. We will not keep this information longer than necessary (this is normally for two years following the end of the contract year); it will then be securely destroyed.

Our full Privacy Statement is available on request and can be viewed on our website at dataadmin@cornwallrcc.org.uk

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No of adults	No of children under 18

What is the activity?	Where will this take place?	When?

Name of item	Name, address & website of repairer/ supplier, if known	Total cost

Name of activity	How many? E.g. 2 people	Cost per person/ session	Total cost

Carers Resilience Enablement Grant Application

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